Title: Prognostic Significance of Nodal and PgR Status on Early Relapse in Operable HER-2 Positive Breast Cancer from the Pre-Trastuzumab Era
Authors: Cho, H
Van Belle, Vanya
Vandorpe, Thijs
Wildiers, Hans
Janssen, Hilde
Leunen, Karin
Amant, Frédéric
Vergote, Ignace
Berteloot, Patrick
Smeets, Ann
Van Limbergen, Erik
Weltens, Caroline
Paridaens, Robert
Van Huffel, Sabine
Christiaens, Marie-Rose
Neven, Patrick
Issue Date: 9-Dec-2009
Publisher: Waverly Press
Host Document: Cancer Research vol:69 issue:24 edition:Suppl. pages:837S-838S
Conference: San Antonio Breast Cancer Conference edition:32 location:San Antonio, USA date:9-13 December 2009
Article number: 6046
Abstract: Background: Over the last decade, trastuzumab has become a standard adjuvant treatment option in HER-2 positive breast cancers. However, with a mainly 'on-treatment' effect only, the economic burden and adverse effects incurred from its routine use for 1 year following completion of chemotherapy, there emerges a need to identify a group of HER-2 positive breast cancers at low-risk for relapse. We, therefore, investigated potential prognostic factors in a cohort of HER-2 positive breast cancers in the era before trastuzumab, especially focusing on hormonal status.
Methods: We retrospectively reviewed the data of 240 trastuzumab-naïve patients with a HER-2 FISH-positive breast cancer who had primary surgery at the University Hospitals Leuven between January 2000 and December 2005. We collected data including age at diagnosis, menopausal status, histologic type, tumor size, grade, lymph node involvement, estrogen receptor (ER)/progesterone receptor (PgR) status, and disease-free survival (DFS) outcome. A multivariate Cox hazard model was used to identify prognostic factors and the cumulative DFS rate was determined using the Kaplan-Meier method.
Results: After a median follow-up of 57.5 months there were 50 breast cancer related events meaning that 5-year DFS rate was 78.4% for the entire cohort. Median time to first event was 20 months and ranged from 4 to 96 months. Cox model revealed that only PgR status and lymph node involvement were independent prognostic factors for disease relapse. (p = 0.03 and p < 0.01 respectively). In Kaplan-Meier analysis, patients with PgR+ showed better DFS rate than those with PgR- (figure 1: 83.8% vs. 73.1%, p = 0.02) while ER status didn't reach statistical significance (p = 0.154). Nodal involvement > or = 4 was strongly associated with poor DFS rate compared with node negativity (p = 0.00). Of note, a subgroup of patients with PgR+ and LN- presented no relapse within the first two years after surgery (figure 2).
Conclusions: In this series of HER-2 positive breast cancers, PgR and nodal status were strong prognostic factors for early breast cancer relapse. Patients with a PgR+/LN- phenotype were unlikely to relapse within the first two years of surgery. We propose to evaluate the added benefit of adjuvant trastuzumab to chemotherapy in women with this phenotype as such data are yet not available from the major adjuvant trastuzumab trials.
Publication status: published
KU Leuven publication type: IMa
Appears in Collections:Laboratory of Experimental Oncology
ESAT - STADIUS, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics
Gynaecological Oncology
Section Woman - Miscellaneous (-)
Multidisciplinary Breast Clinic Section (-)
Laboratory of Experimental Radiotherapy
Surgical Oncology

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